PROCEDURES Frozen sections:     Frozen section rooms are located adjacent to the operating rooms in North and South Hospitals and Dorenbecher with the main f.s. room located in Dillehunt Hall, Room 5036, adjacent to the gross room. If supplies are need for these rooms contact Martin in Histology. Metal chucks should be washed after each frozen section.     The following should be noted on the pathology consultation form at the time they are done. Pathology consultations (when you are called to the operating room to pick up, look at, or open a specimen) and frozen sections diagnoses for those specimens for which frozen section is performed. For billing purposes, only note your own initials on a gross ORC if no staff is involved.     Frozen sections slides are part of the permanent record. They are important both diagnostically and medicolegally. It is the pathologist's responsibility to retain these properly labeled slides. a)    All frozen section slides MUST be labeled with the patient's unit number and name by the     resident/student BEFORE leaving the frozen section room. b)    Frozen sections slides MUST be brought to Surgical Pathology by the resident/student     when the frozen section is completed and a frozen section slide slip filled out and placed with     the slides. c)    Frozen sections slides MUST be placed in histology in the properly marked area (hall table as of     now) at the end of each day. Slide flats can be found in histology.     When an accession number is assigned to the case, labels bearing that number and the numbers of the frozen sections should be affixed to the frozen section slides. For most cases two slides should be made for each piece of tissue frozen. One of each of these slides should be filed with the permanent sections of that case.     If specimens are removed from surgery at the time of frozen section, it should be so noted on the pathology requisition. The specimen should be logged out in the specimen log in surgery and logged in the specimen log in accessioning. Gross Sections: a)    Unlabeled specimens - Occasionally specimens are received in which the containers possess     only the appropriate information pertaining to the patient's name and unit number, while the     accompanying requisition has all of the pertinent information regarding the tissue and site of     biopsy. If the name and unit number on the container correspond to that of the requisition     sheet and the specimens are identified on the requisition, the pathology report should convey     the containers. Specimens whose source can not be identified, either by labeling of the     containers of requisition, will be reported as unlabeled specimens. The clinicians should be     contacted to identify and specimens in which the name and unit number of the container do     not match that on the requisition. b)    Guidelines for submitting tissue: Specimens are received from the hospital in 3-4 batches     during the day. Processor are loaded and begun at 6:00 pm.     1) Rush specimens fall into two categories:         a) If received before 10:00am, the specimen description is hand written on          the accession slip and handed to the histologist with a verbal announcement          that there is a "RUSH". The cassette is placed in the zinc formalin glass          container under the hood in Room 5040.         b) The processors are run daily, the one nearest the hallway for brains, heart bx's          and regular bx's; and the one farthest from the hall for all routines and          autopsies. The biopsy processor can be started anytime up until 10pm. The          routine processor must be started no later than 7pm.         c) If a "RUSH" is received after 10:00am the specimen is dictated as a          RUSH on the dictaphone and given a priority status by pressing #6 on the          dictaphone.          The specimen is processed before any other tissue is embedded. The case is          then signed out, the clinician called, and work resumes as usual.     2) Decalcification cassettes are processed in two separate ways:         a) For a distinctly firm, bony or calcified tissue (ie. Can't be cut with surgical blade          or need pliers to cut, etc.), the word "DECAL" is written on each side of the          cassette and it is place in the decal container. "Decalcification" is written in the          comment section of the specimen worksheet.         b) For a mildly calcified tissue (ie. Can be cut with surgical blade - is gritty) the          specimen is described in the gross description as "submitted for          possible surface decalcification". The cassette is placed per usual in the          cassette holder and "possible surface decalcification" is written in the          comment section of the specimen worksheet.     3) If the tissues are very small and very pale, color them with eosin and wrap in paper. This      makes them more visible to the histotechnologist. Tissues should not be overcrowded      in the cassette. This interferes with proper fixation.     4) For complicated specimens, draw a diagram or photograph a specimen (print      out on printer) and indicate where each section was taken. Mark the diagram      and the sections with indelible ink to orient the section.     5) When a surgical requisition is received which has (Attention Dr.______", the staff should      be consulted BEFORE processing the specimen. If the staff person is not available,      another staff should be consulted.     6) At the time of gross sectioning, a work flow sheet (available in the gross room) should be      completed. It should include accession and cassette numbers for each case, kind and      number of tissue fragments and special handling, such as "on edge", "levels", special stains,      etc... When dictating a regular surgical case, the following format is standard: 1.    FROZEN SECTION DIAGNOSIS: (If appropriate) 2.    G_P_A_ (if appropriate) 3.    LMP (if appropriate) 4.    Known or suspected (if appropriate) 5.    CLINICAL HISTORY: (You are responsible for obtaining history from the clinician; if none is     dictated, NO HISTORY GIVEN will be typed.) 6.    How many specimens, how received, labeled as what (ie, "Received are three specimens, A     and B in formalin, C fresh, labeled A__, B__, C__.) 7.    GROSS DESCRIPTION: (If it is a single specimen) dictate the gross description and how     you submitted it. If the case has multiple specimens the format is as follows: On all specimens a cassette index is used as follows:         SLIDE INDEX:         Cassette A,   cervix at  3:00, RS         Cassette A2, cervix at  6:00, RS         Cassette A3, cervix at  9:00, RS         Cassette A4. cervix at 12:00, RS * The initials RS and AS are used in the cassette indices for all specimens and are described as follows:     RS - representative section submitted. This is dictated when only representative sections of     the tissue are sampled and submitted.     AS - all tissue submitted. This is dictated when all the tissues being described are submitted. **If a specimen is sent somewhere else in the complex, it should be noted in the gross description that it was not received by pathology.     Any specimen which has been examined by pathology prior to its receipt in surgical pathology should be described as it was when first seen (i.e. fresh, unopened, etc.)     Large specimens (breast, bowel, uterus, etc. should be opened, fixed overnight, and submitted the following day. If the specimen is received on Friday evening, it should be sectioned on Saturday or Sunday so that sections will be out Monday.     The rough draft of your dictation will be given to you. You need to read it over thoroughly to make sure that it is correct. Make any corrections on the rough draft and finalized with microscopic description and diagnosis.     A clinical lab printout of any patient is available. Leave the patient's name and unit number at the front desk prior to 8:00am the following morning, and it will be requested for you. Tissue exempt from gross examination:     Therapeutic radioactive sources, the removal of which is guided by radiation safety monitoring requirements.     Foreign bodies (eg. bullets) that, for legal reasons, are given directly in the chain of custody to law enforcement representatives.     Specimens known to rarely, if ever, show pathological change, and removal of which is highly visible postoperatively, such as the foreskin from the circumcision of a newborn infant or child to age 9.     Placentas that are grossly normal and have been removed in the course of operative and nonoperative obstetrics.     Teeth, provided the anatomic name or anatomic number of each tooth, or fragment of each tooth, is recorded in the medical record. Tissue exempt from microscopic examination:     Specimens that by their nature or condition do not permit productive examination, such as a cataract, orthopedic appliance, foreign body, or portion of rib removed only to enhance operative exposure.     Therapeutic abortion specimens on which clinician requests "gross only", recognizable fetal parts are present and no gross abnormality is recognized. (See pg.__)     Traumatically injured members that have been amputated and for which examination for either medical or legal reasons is not deemed necessary. Guidelines for plastic embedding: Only kidney biopsies are routinely submitted for plastic embedding.     Specimens electively submitted for plastic embedding include:     1) Bowel biopsies - if there are many (more than 5-6 sections per case, or if the plastic load is      heavy already     2) Tumor sections - especially if it is a difficult diagnostic problem, check with staff     3) Any interesting or unusual autopsy specimen     4) Testicular biopsies Handling of plastic specimens:     1) Size - tissue should measure 1.3 x 0.7 x 0.2 cm. in maximum size     2) Worksheet - the specimen, labeled, in formalin is left near the small ovens and worksheet.      All pertinent information is recorded, including B5 for those mercuric-fixed samples and your      initials.     3) Processing of the biopsies takes 24-48 hours longer than paraffin sections. Radiography: Radiography of tissue is available through Radiology and setting up an appointment. * Radiology is on the 10th floor of Hospital South. When you go you need the following information in order for correct billing to go to pathology. Radiology: Ph. 4-7654, Rm. 10c70 Fund: 0111001 Org:    364002 Alias:    36400200 They will usually ask if you want a Radiologist to read out the film - tell them NO. These radiographs are for our own use and orientation. Digital photos of the originals can be easily made, by placing original on a light box in a dark room and photographing with the digital camera.